Guest Blog: Uberisation of health services by @DomCushnan

A very good friend wrote this piece and with permission I’m sharing here as find it’s importance critical.

Dom Cushnan is part of the Open Community Lab/MuseomixUK community. He gets how collaboration between sectors breathes creativity and real changes. He gets that private sectors have a role in these changes also – sometimes through action and other times through lessons.

Our community (OCL_Community) is currently planning a remix at an NHS hospital for this summer. Let us know if you’re interested!

The abundance of ever-cheaper, more powerful technology allows small teams with the right approach to accomplish feats previously only achieved within the province of governments and major companies — and to do so faster and more effectively than their bigger competitors.” Nabyl Charania (@nabylc)

There are times in every industry when processes become stagnant even oppressive and if this is not addressed then current attempts at change no longer have the desired effect.

Uber is a prime example of disrupting an industry. By leveraging the abundance of available drivers and the power of algorithmic pricing software, the low-cost vehicle service is replacing traditional taxi fleets, with their endless costs and liabilities. And Uber CEO Travis Kalanick is doubling down on the “urban logistics fabric” that Uber is spinning across the globe, hinting at disrupting logistics across all industries, and launching food delivery pilot programs in Chicago and New York City

But exponential companies aren’t simply more competitive. They’re also, in many cases, the only types of organisations set up for long-term survival.

In today’s world, as products and services are becoming more and commoditised and software is eating the world, entire industries are being disrupted by organisations that are growing at exponential rates. Software algorithms are controlling the on-demand needs of its users.

A complete overhaul, or in this case I like to call it an “uberisation,” of the systems, processes and the healthcare industry in general is needed in order to make it efficient again. This Uberisation is taking place in many industries, and the health sector is not immune, and nor should it be. It is becoming increasingly difficult to ignore the argument that this is where the healthcare service industry is heading, or to some people it has already arrived.
Take the room rental industry as another example at $25.2 billion, Airbnb’s valuation has already surpassed the market cap of major hotel chains like Marriott ($20.6 billion), Starwood ($14.1 billion), and Wyndham ($10 billion), and it’s close to eclipsing that of Hilton ($27.4 billion) as well.

Why is “uberisation” needed in healthcare?

Before delving into how health services can change it is important to look at why they need to. We currently live in a world where we can have what we want and when we want to some large extent. If you want to go shopping in the middle of the night, you can find a supermarket that it open. If you prefer internet shopping, you can place an order and have it delivered to your door within an hour, or two hours if you are outside of one hour area, but two hours is not a long time to wait using services like Amazon Prime Now.

Generations are growing up in an era where they are not expected to wait. Even viewing habits demonstrate this trend as people no longer have to hold on a week to watch their favourite shows, or set a recorder to make sure they don’t miss it. Streaming via Netflix, BBC iPlayer, Amazon Prime and various other services ensure that there is something to watch 24/7 and there is no need to wait.

When it comes to the healthcare services however, the situation is different. In a world where we can order a taxi, it arrive within minutes and you do not have to worry about having the right amount of change because you can use your phone to pay, it seems incomprehensible that it is okay to have to wait at least two weeks to be able to see a GP.

The staff who work in healthcare are usually the first to acknowledge that the service currently being offered is not to the level we all want and try and find ways to influence change. Many services are understaffed and under resourced. This does not mean that staff are not working hard or are unwilling to provide the service that patients need and expect, it just means that they are unable in the current situation/systems to do anything about it. There are change activists who try to push forward new ideas but on the whole, people don’t want to rock the boat because everyone has bills to pay, do their job and go home. A situation has developed where everyone knows something needs to change but it is not happening quick enough or on a large enough scale.

The answer: the technological shift

The rate of technological advancements over the past ten years has left a lot of the healthcare sector unable to keep up. Whether this is a lack of resources, a lack of desire to incorporate technology, or a combination of both is largely irrelevant. Comparing healthcare services to other industries it is clear that technology has a love/hate relationship and has led to a situation where there is a divide between healthcare services in regions through the country and other industries. Organisations are increasingly taking advantage of this gap and developing healthcare services that use up-to-date technology.

While this is nothing new, private healthcare always has an edge by using the latest technology; private health is becoming a standard option for many users, and it is becoming much more accessible. It is not merely that technological advancements are being used within healthcare procedures more frequently, but various organisations are also using technology as a way of allowing people to engage with health services. The Internet allows people to search and find whatever service they need but technologically minded organisations have taken the use of technology even further. An excellent example of this is Babylon App. The Babylon App connects patients to GPs, as well as a range of specialists via a smartphone. Many health related problems do not require the patient and doctor to be in the same room and applications such as the Babylon App employ this fact because it offers an efficient service for people who want to access healthcare on their timeframe. For £4.99 a month you can have access to a GP as many times as required and can usually see a doctor on the day they need to. For further services there are additional charges; however, the App does offer a full range of services that you would expect to be available including referrals and prescriptions. You can also submit a question to be answered for free, purchase test kits and all of your medical records are stored online in your account area. Not only do organisations such as Babylon allow patients to be in control of when they have their appointments, but they also ensure patients have full access to their records and can be part of monitoring their health. Currently a notion that is widespread throughout the healthcare sector.

What is happening to the health care sector?

Currently, numerous exponential organisations are forging a new way of offering healthcare services to the public. Accessing healthcare professionals online are becoming more common and more popular as it offers patients an efficient service that works to their deadlines. Other organisations are focusing on a different aspect of healthcare.

Apple now has the HealthKit, ResearchKit, and CareKit, which allow users of Apple products to be part of their health and care, as well as allowing medical researchers access to large amounts of data. By allowing third party App developers to tap into the health-related aspect of Apple products, consumers now have ways of recording almost everything about their health. From simply inputting information such as blood type, illnesses or medication was taken, to the device recording data like sleep cycles, steps walked, calories burned and pulsed rate. The capability of these devices to analyse the data and provide people with reports means that the general public has the ability to be in possession of much more information about themselves than any medical professional.

23andme also allows people to have access to information about their own health profile that they have never been able to access before. For a price of £125 people can find out more about their genetics, ancestry and how these can impact on health, including what types of medications may work best. In a similar way to the Babylon App, 23andme also allows patients access to their reports and profiles online anytime they want.

This quantified self approach to health and fitness has the potential to transform the health care service for the benefit of patients and professionals. Having access to more information could reduced waiting times as less information gathering may be required, and it also gives doctors a better idea of the patient and their lifestyle as a whole, leading to faster and more accurate diagnoses.

Lets not even get started on AI and big data approach to our health systems but that is another post.

Where is the health care sector heading?

At the moment, it can be seen as a disconnected way of accessing health services, and many people are unaware of what is on offer. Arguably this means that many people are not accessing health services on offer from organisations outside of the NHS because the benefits are not always clear. In the future, it is almost confident that the organisations that provide these different aspects of health services will become much more cohesive. The benefits of having access to healthcare records, tests, and continuous health-related data, as well as being able to see health professionals easily and quickly, will become the norm and will become what the public come to expect. If the current system can’t offer this, then it will become redundant. While many great things are happening and change activists trying to move forward as quickly as possible, it is simply not happening fast enough to keep the public happy, or to compete with the range of exponential organisations sitting on the edge of the healthcare sector just waiting to be called in and take centre stage.

A further change that could be just around the corner is the possibility of having healthcare appointments ‘out of hours’. Without needing to get drawn into the debate about what should or not constitute ‘out of hours’, it is clear that there are hours throughout the evening and night that are not employed for appointments. Machinery shuts down for the night that could be being used to reduce waiting lists and allow more patients to be seen promptly. The question to be answered is whether the public would welcome this type of change (resourcing is another problem to solve). There will, of course, be people who would much rather attend an appointment at 2 am than sitting on a waiting list for months. There are also people who find it difficult to take time off work during the day and would benefit from the option of night time appointments. Undoubtedly there will be opposition to this, however, with the people becoming more accustomed to being able to access what they want at the time they want it, it seems like it will be a natural progression.

What does this mean for patients?

Whilst this is not a discussion of the social impact that these types of changes will have, it would be remiss not to acknowledge that private healthcare will not work for everyone. With more people living below the poverty line, expecting them to pay for health services is largely unreasonable. It is these people who will not have the option to choose to use apps to have GP consultations or pay for health related tests. For these people, the reality will undoubtedly be a situation where the organisation who can save the most money while providing an essential service will take over the responsibility of providing healthcare on a widespread basis.

The most worrying aspect of this type of change is that it could quite easily go down the route of one organisation having a monopoly with no opportunity for competition. In situations where organisations have to bid for the work it is the competition that ensures quality and value for money. In a monopoly the lack of competition would lead to people having less say over their healthcare services because without the possibility of losing work there is less incentive to provide a service that the public want. Capitalism and making a profit should not be viewed in an entirely negative way. There is nothing wrong with capitalism as long as there is a fair competition which leads to a service that patients are happy to access.

It is impossible to lay the blame for the failings of the health services at one thing or any one person’s door as many factors have led to the situation that is currently being experienced. Long waiting lists, understaffed and under-resourced services, health boards with huge deficits, demoralised staff, etc. do not happen over night. Small changes to try and repair the damage and get the health service back are track no longer sufficient. What is needed now is for it to be acknowledged that the current system does not work and “uberisation” is the next logical and necessary step. Technological advances need to be incorporated into health services because they offer the best form of care in many situations. The quantified self is not something that should be feared or mocked but embraced as a way of people taking control of their healthcare journey. It allows patients and professionals to be more informed and should be encouraged. Currently, the entire health sector is disconnected, with serious differences in the level and standard of service offered in differing locations. “uberisation” of the area of health needs to bring a cohesive approach that provides a high quality of service, with flexibility for patients but that does not exclude any section of society. To achieve this the time has come for a complete overhaul and anything less is destined to fail.

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